Thank you for sharing our medical story about my husband, Mark Prince.
Patient: Mark Prince - 59 year-old male, non-smoker, 4 x beers per month drinker. No hypertension, no diabetes, no depression, no previous surgeries. Non-driver; exercise consists of walking 4km per day to work. Job entails walking up to 5- 10km per shift. For twelve years Mark is the night duty orderly in the Emergency Dept at our local public hospital.
Pre-episode: Mark was showing signs of exhaustion and he was constantly fatigued. Five days prior to his event, Mark set out for a walk with elevation. He was unable to complete hike due to shortness of breath, fatigue. His life consisted of working and sleeping. There never seemed to be enough sleep time even though Mark was having no trouble in having quality sleep.
History: Early childhood, Mark was diagnosed with a heart murmur. The murmur was never investigated. The murmur has always been documented in medical charts. Marks heart beat was so loud you could hear it when embraced in a hug.
Episode: 5th May, 2019: Mark was working in the ED, his description of “I felt heavy in my feet, I couldn’t get my time management or a rhythm at work. I just felt so slow” Blood pressure was 130/75 and pulse 75. Hydrated with lemonade and continued working. Marks first syncopal episode, ironically, was in a trauma bay. He fainted for 30 secs, sat up, shook it off and had a second syncopal. ED physician noted previous vitals and acknowledged that he was not presenting with any other markers to explain his two syncopal episodes. “How long have you had a heart murmur?” “Think we need to check this out”. Note: patient adamantly dismissed the idea of warranting unnecessary tests as he had no chest pain, no previous weakness in arms or legs, “had the murmur all my life, just let me go back to work doc!”
Diagnosis:
Bicuspid Valve; Severe Aortic Stenosis; LAD (Left Artery Descending); Calcification of the Aortic root, stem, arch; Aortic dissection-type A; Atherosclerosis - occlusion 70%
Plan: Cardiothoracic surgeons treating at the hospital categorized Mark as level 2.
Surgeries within a 12 week timeframe: Angioplasty for (Left Artery Descending) LAD diagnosis - 85% blockage; Two stents inserted into the above artery; Transcatheter Aortic Valve Implantation’ TAVI inserted to rectify bicuspid valve opening of 0. 5 cm.
Outcomes:
Calcification of ascending to aortic arch - non treatable; Heart replacement option - non treatable; Aortic Dissection - treatment via Beta blocker - Metoprolol; Vascular Team to treat occlusion deferred due to Covid-19
Home monitoring of BP < 120 systolic with pulse rate sitting between 45-55 beats per minute; Daily medication: 25mg metoprolol, 40mg Atorvastatin, 100mg aspirin.
Marks vitals now sit at 110/60 and pulse 50; Daily exercise consists of flat ground walking, no lifting >5kg, no plyometric exercises; No intimacy; Patient not able to return to work - medically retirement required. ** note - patient had income protection of 75% of his wage therefore no additional financial pressures added to medical stress.
Pt goals:
Due to uncertainty of TAVI +/- 5yrs? due to uncertainty of stability of dissection, due to uncertainty of stroke? Mark has a positive attitude on what life has to offer. We are packed and ready to travel to UK to watch his beloved football.
Marks advice to doctors - you all speak too fast! So much information is divulged for us to process. Be more direct, clear, concise with your communication. Sometimes we don’t need to hear the “niceties” we just need a direct answer. We need to hear strength, confidence in your voice tone; eye contact!
We are so lucky to have an ED doctor insist “lie down, shut up, let me do my job”
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